Pediatric Migraine Management: Migraine Drugs Plus Vitamins Help Prevention

Pediatric migraine medications, including topiramate and pregabalin, are associated with a reduction in headache frequency and intensity; however, none of them are found to improve quality of life. The use of vitamin supplements in combination with these drugs may help with pediatric migraine management. These are the findings of a meta-analysis published in JAMA Network Open.

To develop effective therapeutic strategies for pediatric migraine, understanding the safety and efficacy of pharmacologic interventions for migraine prophylaxis is important.

Researchers conducted a systematic review and network meta-analysis to study the use and benefits of treatments for pediatric migraine, as well as the effectiveness of interventions involving these medications.

Databases, including PubMed, Embase, SCOPUS, and ClinicalTrials.gov, were searched for studies about the efficacy of pharmacologic treatments for pediatric migraine.

Primary outcome was post-treatment headache frequency, defined as number of migraine attacks per month. Secondary outcomes included headache frequency, defined as at least a 50% reduction in headache frequency after treatment; headache duration, defined as duration of an individual attack, as measured in hours; migraine-related disability, measured by the PedMIDAS tool developed for children and adolescents; and self-reported headache intensity, measured on a scale from 0 to 10.

Of 9162 citations identified, 45 clinical trials were eligible for the current analysis. The majority of participants were from Iran (n=1587; 42.08%).

Analysis of the primary outcome included all 45 studies, with 2617 pediatric patients. The researchers found that pregabalin, topiramate, flunarizine, levetiracetam, riboflavin, cinnarizine, and amitriptyline vs placebo were all associated with a lower frequency of migraine, with a 62% reduction in migraine frequency with pregabalin. Additional vitamin D3 supplementation with riboflavin and pregabalin was found to have a superior response vs placebo or pregabalin alone.

A total of 29 of 45 studies, including 2801 patients, reported at least a 50% responder rate, with a significant effect size with flunarizine, pregabalin, and cinnarizine compared with placebo.

As observed from 19 of the 45 studies, propranolol, pregabalin, valproate, levetiracetam, and cinnarizine vs placebo all had a significant effect size in reducing migraine intensity vs that of placebo.

None of the treatments were associated with a significant reduction in disability or quality of life, as well as headache duration, in pediatric patients.

Overall, 30 of the 45 studies assessed safety and adverse events with migraine treatments; 14.6% of patients had mild adverse events and approximately 1% discontinued study participation due to serious adverse events. Compared with placebo, amitriptyline, topiramate, and valproate had a higher risk for adverse events.

Limitations of the analysis were the differences in baseline values of outcomes, such as migraine frequency and duration, which may have compromised the validity of the findings; some studies included testing of treatments in a smaller sample size; heterogeneity across studies in terms of dosages, treatment formats, and reporting methods, which may have influenced outcomes; and potential bias and the lack of generalizability to patients outside of Iran.

“The study underscores the potential benefits of combination therapies, particularly those involving vitamin supplementation, and emphasizes the importance of larger, randomized clinical trials to confirm these findings and explore new avenues for enhancing care in pediatric migraine management,” the researchers concluded.